Delilah Saunders has been airlifted from Ottawa General hospital to Toronto where she will be assessed at one of the largest liver transplant centres in North America.

The young Indigenous advocate is at the centre of a fight by her family and friends to get her a potentially life-saving liver transplant. Earlier, her family was told Saunders, who is in critical condition with acute liver failure, did not qualify for a transplant because of her use of alcohol during the past six months.

But Thursday evening, the family got word from Toronto General Hospital that it wanted to see her for an assessment. Saunders’ aunt Barbara Coffey said she was sent by air ambulance to Toronto on Thursday evening.

“We don’t know what the outcome will be, it is for an assessment.”

Saunders, who has been at The Ottawa Hospital for a week, was initially rejected by the Toronto transplant centre as a transplant candidate, said her aunt. Officials there told this newspaper they are beginning a pilot program next year to find a better way to assess whether people who damage their liver through alcohol will be good candidates for a liver transplants. Until then, they said, their hands are tied by the rule that requires six months of sobriety before a transplant for those whole liver damage is alcohol related.

The Trillium Gift of Life Network, which is in charge of transplants, said the six-month rule “does not prevent a health-care provider from referring a patient to a transplant program, nor does it prevent a patient from receiving a consultation.”

Saunders, who received Amnesty International’s ambassador of conscience award this year for work on missing and murdered Aboriginal women, went to the General campus of The Ottawa Hospital on Friday with severe abdominal pain. She was diagnosed with acute liver failure, likely brought on by taking too much acetaminophen for wisdom tooth pain, according to her family.

Saunders’ mother, Marian, said a physician told her Tylenol poisoning caused her daughter’s liver failure. She said she was also told her daughter wasn’t a candidate for a liver transplant because she had been abusing alcohol during the past six months. Acetaminophen is more likely to critically damage livers of people who also abuse alcohol or have underlying liver damage.

Her rejection from several transplant centres was something her family kept from Saunders, who has been in and out of consciousness. “Delilah doesn’t know she has been refused a transplant,” said her aunt, Barbara Coffey.

Coffey said doctors at The Ottawa Hospital, which does not perform liver transplants, contacted transplant centres in Toronto, London, Ontario and Montreal, but they refused to accept the young woman as a transplant candidate. Saunders has fought addictions in the past, say family members, although acetaminophen appears to be the direct factor in her liver failure.

Family members are travelling from across Eastern Canada to be at the young Inuk woman’s bedside, Coffey said.

Saunders’ health crisis comes three years after the high-profile murder of her older sister, Loretta, a masters student in Halifax who was working on a thesis about missing and murdered Indigenous women at the time. Delilah Saunders became an outspoken advocate for missing and murdered Indigenous women after her 26-year-old sister’s death, something that hit her hard, say family members, who describe it as a factor in her battle with addictions.

Saunders’ condition, and the refusal from transplant centres, comes as a blow to the family still dealing with her older sister’s death.

“Loretta was murdered, there was no choice,” said Coffey, speaking through tears. “Delilah could be saved. But she might die because she has a history of addictions.”

The Saunders family has hired a lawyer and wants to file an injunction against the so-called six-month rule for liver transplants, if necessary. On Friday, family members were travelling to Toronto to be with Saunders and anxious to hear the results of her assessment.

A Toronto widow, Debra Selkirk, who began a legal challenge against he six-month rule after her husband died of liver failure, has been in touch with Saunders’ family. Selkirk said Thursday she believes Saunders would have been on top of the list as a candidate for a liver transplant if not for the six-month rule, which Selkirk argues is unscientific, unfair and unconstitutional.

“I believe that if this rule was not in place, they would have medevacked her to Toronto immediately for transplant, she said earlier.

“Don’t let her die,” Selkirk said. “Transplant her today.”

Saunders’ case brings into sharp relief some of the ethical questions involved in decisions about how a limited supply of donor organs are doled out.

Every week, 1.5 patients die on waiting lists for livers at Toronto Genera, part of the University Health Networks. Officials there are beginning the pilot project next year in an effort to find a fairer means of determining which patients are more likely to do better after a transplant, including continuing to abstain from alcohol, said transplant hepatologist Dr. Les Lilly. He said transplant officials are going to try using a more “global assessment of (a patient’s) real risk of relapse to alcohol.”

In a statement, Trillium Gift of Life Network said the so-called six-month rule is based on expert advice and is commonly used in Canada and around the world. “However, this does not prevent a health-care provider from referring a patient to a transplant program, nor does it prevent a patient from receiving a consultation by a transplant program.”

The three-year pilot program will determine if there is an “evidence-based basis” to change the rule.

Selkirk said the six-month sobriety rule is based on faulty assumptions that people who have not been able to abstain from alcohol for six months do not do well when they receive a new liver and that many return to drinking. Selkirk said research does not support that, but shows the opposite, that those who have not abstained do well after liver transplants and that few return to drinking.

Six-month sobriety rules are common around the world. But some see the rule as outdated and based on poor public perception of alcohol addiction.

Selkirk’s husband was unable to get a liver transplant, even though she volunteered to donate a piece of her own liver. She said she has seen others, including a young man whose liver was damaged from acetaminophen, who have died while waiting the six months.

Lilly of Toronto’s United Health Network said there is still a big gap between supply and demand of livers for transplant, which is why is it crucial to determine which candidates are most likely to have successful transplants. “We are the marshals of a very scarce resource. The major message is that the supply still comes nowhere close to meeting the demand.”

Saunders’ family, meanwhile, say they they are determined to do everything they can to fight for her life — including challenging the sobriety rule.

Coffey said Thursday the family is also getting advice from Amnesty International, “which sees this as a human rights issues.”

Earlier this year, Saunders was interviewed in Teen Vogue magazine by musician Alicia Keys, who also received an Amnesty International award. A friend said the family was trying to contact her for support.